Gum disease, or periodontal disease, is commonly associated with the presence of bacterial pathogens within periodontal pockets between the dentin and gum tissue. Gingivitis describes a periodontal condition of inflammation within the superficial layers of the periodontium. Periodontitis is advanced Gingivitis, whereby the inflammation is extended to the underlying tooth supporting structures and other deep periodontal tissues. Attachment loss and gum recession is symptomatic of advance gingivitis or periodontitis which can leave extremely sensitive portions of underlying tooth supporting structures exposed.
Ultimately, periodontitis leads to the destruction of both supra-alveolar and periodontal fibers as well as the adjacent portion of the alveolar bone which generally provides for the attachment of healthy soft periodontal tissue to the cementum. When the soft periodontal tissue becomes inflamed as a result of bacteria, the edematous and junctional epithelium recedes away from the cementum creating an enlarged periodontal pocket and attachment loss of the soft periodontal tissue to the cementum.
Enlarged periodontal pockets provide collection sites for plaque and calculus which adheres to root surfaces. Calcified plaque and calculus provide rough surfaces which are a highly suitable environment for hosting and colonizing bacterial pathogens. One category of bacterial pathogens which has been strongly implicated in the progression of periodontal disease are referred to as gram (-) anaerobic pathogenic bacteria.
Periodontal bacteria have been shown to migrate into surrounding soft tissues and survive within endothelial cells, macrophage and perivascular cells. Periodontal bacteria can also survive in hard periodontal tissue including dentin, bone and cementum tissue. Periodontal bacteria can also enter into the general circulation system through various systemic routes and mechanisms.
Periodontal disease has been correlated to several systemic conditions, such as cardiovascular disease, and is thought to contribute to other heath problems including pre-term delivery and low infant birth weight for infants delivered from mothers having periodontal disease. While there is no comprehensive list of health related problems associated with periodontal disease nor is there a complete understanding as to whether periodontal disease is aggravated by other health conditions or vise-versa, it is commonly believed that periodontal disease can propose a health risk.
The most effective therapy for gum disease is to motivate patients to improve their personal oral hygiene habits. Unfortunately, attachment loss is a progressive condition due to the activation mechanisms of collagen destruction and bone resorption. Therefore, adhering to a aggressive maintenance regimen will not typically improve the gum recession. However, gum recession can be stopped, or at least the rate of gum recession can be significantly reduced.
Topological antibiotic therapies are usually ineffective in the eradication of periodontal bacteria because a portion of the bacteria which survive such therapies and can re-colonize. Bacteria survive topological antibiotic therapies by virtue of being isolated deep within dental calculus and/or intracellular locations of periodontal tissues and are, therefore, topologically privileged. Systemic antibiotic therapies are also typically ineffective in the eradication of periodontal bacteria because dental calculus and intracellular locations are also systemically privileged and not accessible by the host's circulation system. Besides being ineffective, antibiotic therapies can lysis non-privileged bacteria causing fragments of the bacteria to enter the blood stream and result in “endotoxic shock” or “septic shock” to the patient.
Because of the numerous shortcomings of antibiotic therapies, mechanical methods are usually employed, either solely or in combination with antibiotic therapies. Mechanical procedures, also referred to herein as debridement, include removing calculus, diseased cementum and/or necrotic soft tissue within the gingival sulcus containing the bacteria. These procedures are more commonly referred to as scaling, root planing and sulcular debridement. In debridement procedures, a curette, ultrasonic scalar or any other suitable device is used to remove infected or diseased tissue from healthy tissue with the intent of reestablishing attachment of the remaining healthy soft periodontal tissue.
There are even more aggressive treatments for patients with highly advanced periodontitis. In these more aggressive treatments flaps from the gum tissue are cut and removed or pulled away from the root structures in order to access the root surface so that the diseased tissues can be removed. After the diseased tissues are removed, the gingival flaps are sutured back into place. Grafting procedures are also frequently used to “build-up critical tissues” around dentition, wherein the critical tissues have been depleted from periodontitis or treatments thereof.
In addition to the obvious discomfort suffered to the patient during and after these aggressive mechanical treatments, such mechanical treatments also have several shortcomings. Mechanical treatments are not a cure for periodontitis because pathogen may survive within the periodontal tissues. Even a small amount of living bacteria within the soft tissues, hard tissues or semi-hard tissues can allow the bacteria to re-colonize quickly after the treatment. Mechanical treatments can result in the systemic release of toxic bacteria fragments leading to toxic shock and possible other health problems. Also, mechanical treatments can only be implemented a limited number of times without requiring oral surgery and/or grafting of gum tissues. Some patients are, unfortunately, highly susceptible to periodontal disease and debridement is not a viable long term solution to prevent the advancement of attachment loss of the soft periodontal tissue to the cementum.
What is needed is a system for and method of treating pathogens within an oral cavity. Further, what is needed is periodontal treatment which can be used to treat periodontal tissues in the early phases of periodontal disease and which can be administered multiple times without causing serious trauma to gum tissue and without causing significant systemic release of toxins from treated pathogens.